This paper is only available as a PDF. To read, Please Download here.
Background
Diagnostic stewardship can be a high-impact, low-effort strategy to optimize clinical
outcomes through implementation of evidence-based guidelines and electronic health
record (EHR) decision support. Published practice guidelines indicate appropriate
indications for diagnostic urine cultures for evaluation of urinary tract infection.
Methods
A multidisciplinary team reviewed current evidence-based practice guidelines and developed
a urine culture algorithm including a list of approved indications and updated urinalysis
(UA) reflex to culture criteria. The protocol was implemented into the electronic
health record, including requirements for the providers to list an approved indication
for urine culture, and updated UA reflex criteria. Number of urine cultures tested,
number of catheter-associated urinary tract infection (CAUTI) events, and CAUTI rate
was assessed pre and post protocol implementation.
Results
Urine cultures, CAUTIs, and CAUTI rates were reviewed for one year prior to implementation
and one year after implementation, 03/2019-02/2020 and 03/2020-02/2021. Comparing
the baseline year of data to the year after implementation revealed that the implementation
of the urine culture algorithm resulted in a 23.5% reduction in the amount of urine
culture tests completed (p<.001). A 15.9% CAUTI reduction and a 23.3%5 CAUTI rate
reduction were also obtained.
Conclusions
Diagnostic stewardship can be an important part of an infection prevention program.
The implementation of an evidence-based urine culture algorithm resulted in a statistically
significant reduction in urine culture tests. A reduction in CAUTI events and CAUTI
rates were also obtained. Integrating the algorithm into the electronic medical record
and obtaining input from a multidisciplinary team were key components to achieving
successful implementation.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Article info
Identification
Copyright
© 2022 Published by Elsevier Inc.
